tbuckley/cabot-search huggingface dataset:
Abstract 15680: Impact of Heart Failure on Peri-Procedural Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Ramtej Atluri, Mouna Kodali, Sreeram Yalamanchili, Meghana Vallabhaneni, Sami Shoura, Mukunthan Murthi, Sujitha Velagapudi, Prajwal Shrestha
Journal: Circulation (2022)

Introduction: Transcatheter aortic valve replacement (TAVR) is rapidly becoming commonplace for hemodynamically significant aortic stenosis (AS). Heart failure (HF) is a common comorbidity in aortic stenosis patients. Prolonged elevated left ventricular pressures result in progressive left ventricular hypertrophy and remodeling which in turn predisposes to the HF. Since many who undergo TAVR for AS could have HF, we aimed to assess periprocedural outcomes in this population. Methods: We utilized the National Inpatient Sample from 2016-2019 to identify 217,575 hospitalized adults who underwent TAVR for AS. These hospitalizations were further stratified based on the presence of HF. A multivariate regression model was used to adjust for confounders and analyze the variables. Results: Of those who underwent TAVR for AS, 146,770 (67.4%) had HF. Those with HF had a higher proportion of males (47.3% vs 41.6%; p&lt;0.001). Figure 1 shows the Forrest plot for multivariate analysis of peri-procedural complications when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, patients with HF who underwent TAVR had longer length of stay (LOS) by 0.89 days (p&lt;0.001) and had additional hospital costs (HC) of $13,297 (p&lt;0.001). Conclusions: Patients undergoing TAVR with co-existing HF had significantly worse outcomes in terms of LOS, HC, atrial flutter, AKI, sepsis, pneumonia, and endotracheal intubation. Patients with severe AS may have altered myocardial contractility and periprocedural hemodynamic shifts may be poorly tolerated due to structural and functional impairments that persist even after correction of afterload. Despite the risk of periprocedural outcomes, the benefit of ventricular unloading particularly in those with preserved or mildly reduced ejection fraction should not be overlooked.
Abstract 15839: Complication and Readmission Outcome of Atrial Fibrillation Catheter Ablation Among Cancer Patients
Authors: Lingling Wu, Bharat Narasimhan, Zhuoran Yang, Kirtipal Bhatia, Pengyang Li, Arti Shah, Bharat K Kantharia
Journal: Circulation (2022)

Introduction: Catheter ablation (CA) has been increasingly utilized among patients with atrial fibrillation (AF) as a guideline-supported treatment. However, limited data is available regarding its safety among cancer patients. Hypothesis: Patients with a cancer diagnosis has worse outcome following AF CA Methods: We queried the 2016 to 2019 United State Nationwide Readmission database to identify all patients with (active cancer or a history of cancer) or without cancer diagnosis who underwent AF CA. Hospital outcome and 30 days readmission rate were analyzed. Multivariate logistic regression or Cox proportional hazards regression analysis was employed when appropriate adjusting for comorbidities as well as patient and hospital-level factors. Results: A total of 46,461 AF CAs were included in the analysis, among which 800 (1.72%) patients were diagnosed with active cancer and 5,133 (11.04%) patients had a history of cancer. Compared to non-cancer patients, patients with a cancer diagnosis were older and more likely to be female (Table 1). Patient with cancer diagnosis also has a higher burden of comorbidities, stroke risk, and bleeding risk as evidenced by Charlson Comorbidity Index, CHA 2 DS 2 -VASc score, and ATRIA score (Table1). As a result, patient with active cancer has higher inpatient hospital mortality, procedural complication rate, and all-cause readmission rate. After adjusting for confounders, active cancer diagnosis but not a history of cancer was associated with increased hospital mortality (Odds ratio: 2.72[1.18-6.24] p=0.018 vs noncancer) In contrast, only a history of cancer was associated with a small increased risk of 30 days readmission following CA (Hazard ratio: 1.19 [1.04-1.37) p=0.009 vs noncancer). There was no difference in procedural risk between cancer and non-cancer patients. Conclusions: Active cancer but not a history of cancer was associated with increased in-hospital mortality among AF patients who underwent CA.
Abstract 15605: Underrepresentation of Cardiologist Demographics in Review of Medicolegal Cardiology Cases
Authors: Mehul Patnam, Mladen I Vidovich
Journal: Circulation (2022)

Introduction: Cardiologists face an increased risk of medical professional liability (MPL) claims compared to physicians overall throughout their careers. Simultaneously, male physicians are over twice as likely to encounter medicolegal litigation than female physicians. Understanding the distribution of MPL claims across cardiologist demographics is vital to identify high risk areas and improve quality of patient care. Thus, we aimed to characterize current literature on the inclusion of demographic data in medicolegal cases against cardiologists. Methods: Searches were performed in the PubMed database. An initial search using a combination of the terms “cardiologist,” “cardiology,” “cardiac,” and “malpractice” yielded 802 results. Studies were screened by title and abstract for 1) relevance and 2) acquisition of data from a legal or insurance database. Data was manually extracted from eligible studies and categorized into 18 legal and demographic fields. Results: After applying eligibility criteria, 21 studies were analyzed. Comparison of key variables revealed an underrepresentation of cardiologist demographic data compared to patient data (Table 1). While two-thirds of medicolegal studies in cardiology described patient gender, no studies included gender of the defending cardiologist. Similarly, though two-thirds of studies mentioned patient age, none included cardiologist age. There was no mention of patient or cardiologist race in any of the 21 studies reviewed. Conclusion: In conclusion, knowledge of gender- and race-specific litigation patterns against cardiologists is absent from literature. Despite descriptions of patient characteristics, current studies on the medicolegal landscape of cardiology ignore key cardiologist variables. Incorporating demographics of prosecuted cardiologists could help elucidate the role of gender and race in medicolegal cases, minimize litigation risk, and enhance patient care outcomes.
Abstract 244: Accelerating AED Use In Out-of-Hospital Cardiac Arrest With Combinations Of First Responder And Drone Delivery To Achieve 5-minute AED Deployment
Authors: Monique A Starks, Jamal Chu, Benjamin Leung, Timothy Chan, Audrey L Blewer, Denise Simmons, Anjni Joiner, Jose G Cabanas, Matthew Harmody, Darrell Nelson, Tyson Clark, Bryan McNally, Christopher B Granger, Daniel B Mark
Journal: Circulation (2022)

Background: Defibrillation in the critical first minutes of out-of-hospital cardiac arrests (OHCAs) can significantly improve survival rates but getting timely access to AEDs is a major barrier. We estimated the potential of a statewide program for drone-delivered AEDs in North Carolina (NC) when integrated into EMS response that includes police and fire first responders (FR). Methods: Using CARES registry data, we included all patients &gt;18 years with OHCA occurring between 1/1/2013-12/31/2019 in 44 NC counties. We determined the improvement in AED arrival time by providing AEDs to all FR, who routinely arrive earlier than EMS but currently may not have an AED. We developed mathematical models to place drones within each county to achieve 5-min AED arrival times for 75% of OHCAs in each county. We predicted ambulance response times and resulting drone dispatch decisions using linear regression. Models were trained using 2013-2018 OHCA data and were validated with 2019 data. Mean response times were compared with historical response using the Wilcoxon signed-rank test. Results: We identified 27,199 OHCAs with historical median county-level response times of 6.7 [IQR: 5.9-7.5 mins]. Providing all FR with AEDs reduced response times to 5.9 [IQR: 5.3-6.9] mins and increased OHCAs with AED arrival times of &lt;5 min to 35.6% [IQR: 26.1-43.4%]. Mathematical models estimated that 273 optimally located drones across the 44 counties would reduce response times for out-of-sample OHCAs to 3.7 [IQR: 3.4-3.9] mins and increase OHCAs with AED arrival times of &lt;5 min to 73.0% [IQR: 65.4-78.8%]. The drone network improved response times (p&lt;0.05) compared to historical response times in 43 out of 44 counties. Conclusion: Full deployment of AEDs by FR plus optimized drone AED delivery was estimated to significantly improve response times based on historical patterns of OHCA in NC. The number of drones and their impact varies across counties based on OHCA incidence rates and population density.
Abstract 193: Leading Causes Of Traumatic Cardiac Arrest In The United States: National-level Surveillance
Authors: Aditya C Shekhar
Journal: Circulation (2022)

Introduction: Out-of-hospital cardiac arrest secondary to traumatic injury is associated with extremely poor survival, even when compared with other etiologies of cardiac arrest. Traumatic cardiac arrest is extremely preventable if the original injury causing the arrest can be prevented. Hypothesis: From a public health standpoint, there is an urgent need to identify the specific causes of traumatic cardiac arrest with the hopes of specifically targeting prevention efforts. Because they are the first responders to all types of out-of-hospital cardiac arrest, data from the emergency medical services (EMS) perspective may be invaluable in this effort. Methods: In order to provide a broad, descriptive overview of the causes of traumatic cardiac arrest in the United States, we examined a national-level database of EMS runs in the United States (NEMSIS). This database is populated directly from information entered in EMS patient care reports by more than ten-thousand EMS agencies, allowing us to provide a nationally-representative description of cardiac arrest trends. We examined traumatic cardiac arrests responded to by EMS between January 2017 and December 2021 where EMS documented the primary mechanism of injury. Results: A total of 70,712 traumatic cardiac arrests met inclusion criteria. There were significantly more male patients (78%) than female patients (22%). A majority (73%) were in patients between 18 and 65 years of age; 20% involved patients older than 65 years and 7% involved patients under 18 years. Across both sexes and all age groups, the two common arrest causes were crash-related injuries (36%) and firearm-related injuries (28%). However, compared with other age groups, arrests in elderly patients were more likely to be caused by intentional self-harm and, compared with female patients, arrests in male patients were more likely to be caused by assault. Conclusions: Our results offer important preliminary surveillance on the causes of traumatic cardiac arrest in the United States. These results can hopefully lay the foundation for important public health efforts aimed at preventing cardiac arrest and mortality from traumatic injury; crashes and firearms may represent two foci of interest.
Abstract 15707: Age Does Not Modify the Impact of Natriuretic Peptide-Guided Therapy on Clinical Outcomes or Serial Natriuretic Peptide Levels
Authors: Caleb J Hood, Anand Gupta, Nicholas S Hendren, MaryJane A Farr, Mark H Drazner, Wai Hong W Tang, Justin L Grodin
Journal: Circulation (2022)

Introduction: Older age is independently associated with greater NT-proBNP levels. As such, the aim of this study was to establish the influence of age on serial NT-proBNP levels over time and the impact of age on response to natriuretic peptide-guided therapy (NPGT) versus usual care for heart failure with reduced ejection fraction (HFrEF). Hypothesis: Age will modify the effect of NPGT on serial NT-proBNP in patients with HFrEF. Methods: Using data from GUIDE-IT, the impact of age on the association of NPGT with serial NT-proBNP and long-term outcomes was assessed. Time-to-event analyses and generalized linear mixed modeling were used to evaluate the effect of age, by quartile, on long-term outcomes and serial NT-proBNP by randomized treatment (NPGT vs. usual care), respectively. Results: In this cohort (N=893), the median age was 63 [range 21-90, IQR 53-71] years and was 32% female and 36% black race. Age was modestly correlated with NT-proBNP (Spearman rho 0.34, p&lt;0.001). At baseline, older age was associated with lower doses of ACEI/ARB (p-trend 0.019) and aldosterone antagonist use (p-trend&lt;0.001), but not beta-blocker use (p=0.06). Older age was associated with a greater risk of all-cause death (log-rank, p&lt;0.001) but not associated with a greater risk of combined CV death or HF hospitalization (log-rank, P=0.56). Although older age was associated with greater NT-proBNP levels over time (Q4 vs. Q1 beta 2.1 x pg/mL/days, p&lt;0.001), it did not modify the association of NPGT on serial NT-proBNP ( Figure, Q4, Q3, and Q2 vs. Q1 by treatment arm, p-interaction&gt;0.09 for all). Age also did not modify the impact of NPGT on either mortality or the composite, CV death or HF hospitalization (P-interaction&gt;0.05 for both). Conclusions: Older age was associated with greater NT-proBNP levels. However, age did not modify the association of NPGT on clinical outcomes or serial NT-proBNP. These data do not support the hypothesis that age modifies the NT-proBNP response to HFrEF treatments.
Abstract 15740: Association Between Intimate Partner Violence and Major Adverse Cardiovascular Events: Findings From the Coronary Artery Risk Development in Young Adults (Cardia) Study
Authors: Kathryn Recto, Laura A Colangelo, Kiarri N Kershaw, Donald M Lloyd-Jones
Journal: Circulation (2022)

Background: Data are limited on the associations between intimate partner violence (IPV) in young adulthood with the incidence of cardiovascular (CV) events in middle age, and it is unclear how these associations may be affected by other CV risk factors. Methods: We included up to 4357 CARDIA participants (ppts). Exposure variables measured at baseline (1987-1988) included how often in the past year ppts became involved in a violent argument 1) with a spouse/lover (IPV), 2) with family other than spouse, 3) with someone else they knew, 4) with someone they did not know, and 5) whether the ppts kept a gun at home for protection. Over 28 years of follow up, we assessed incident CV events (defined as non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalization, and other CV death) and total mortality. We used Cox models to examine associations between violence exposure status and incidence of CV events or total mortality, with additional adjustment for baseline risk factors. Results: At baseline, mean age was 27 years with 54% female ppts. Ppts exposed to IPV in the last year were more likely to be Black (62% vs. 42% of those unexposed to IPV). Ppts with at least one violence exposure in the past year also had higher rates of alcohol use, smoking, and depression. With adjustment for age/sex/race, exposure to IPV, family violence, and keeping a gun were associated with incident CV events and total mortality (Table). While these associations were attenuated with adjustment for CV risk factors, most of those for total mortality remained statistically significant with hazard ratios for “more than 1 time” ranging from 1.26 to 1.59. Conclusions: Among young adults, having at least one violent episode in the past year with a spouse/lover or family member was significantly associated with incident CV events and total mortality. These associations were attenuated after adjusting for additional variables, such as smoking, as this high-risk behavior may lie in the causal pathway.
Abstract 15652: Insurance Status Alone Does Not Explain Increasing HF Mortality Among Young Adults
Authors: Tracy Shirey, Shivani A Patel, Alanna A Morris
Journal: Circulation (2022)

Introduction: Heart failure (HF) mortality among young adults has been increasing since 2012. It is unknown if insurance status contributes to these trends. Hypothesis: Uninsured status contributes to rising HF mortality rates in young adults across US states over the last decade. Methods: State-level age-adjusted mortality rates for HF and all cardiovascular disease (CVD) in adults aged 25-64 from 2010-2020 were obtained from the National Center for Health Statistics. All deaths across fifty states and the District of Columbia (DC) were included, averaging 3.3 million individuals per year. Annual estimates of the percentage of uninsured adults ages 25-64 (% uninsured) from the US Census were merged with mortality data by state and year. We examined cross-sectional associations of % uninsured with HF and CVD mortality in each year. We further examined the longitudinal association of % uninsured and mortality outcomes across years using linear regression models with generalized estimating equations to account for the longitudinal design. Results: Across n=51 US states and DC, the age-adjusted HF mortality rate increased from a mean of 6.48 in 2010 to 7.54 in 2020 (p&lt;0.001), while the age-adjusted all-cause CVD mortality rate increased from 78.71 in 2010 to 88.91 in 2020 (p&lt;0.001). Over the same period, the % uninsured decreased from 19% in 2010 to 11% in 2020 (p&lt;0.001). In 3 of 10 years, there was a significant association between % uninsured and HF mortality (β ranging from 15.94 to 25.01 deaths per 100,000 in 2010, 2015, and 2020; p&lt;0.01,) and CVD mortality (β ranging from 166.48 to 258.48 deaths per 100,000 in 2010, 2015, and 2020; p&lt;0.01). The longitudinal association between % uninsured and HF mortality was not significant (β=1.81 deaths per 100,000; p=0.44). Conclusion: Uninsured status is associated with HF and overall CVD mortality across US states in certain years, however, there is no association between uninsured status and HF and CVD mortality rates from 2010-2020.
Abstract 15548: Rare Association of Arrhythmogenic Left Ventricular Cardiomyopathy Phenotype of Titin Mutation of Uncertain Significance
Authors: Syed Faiz Abbas, Omofolarin Babayale, Swati Chand, Devesh Rai, bipul baibhav
Journal: Circulation (2022)

Case Presentation: A 67-year-old female presented to the office with exertional dyspnea, atypical chest pain, palpitations, and dizziness. She had a past medical history of hypertension, hyperlipidemia, mitral valve prolapse, and moderate mitral regurgitation. Her EKG identified multiple PVCs requiring the placement of a Holter monitor, a PVC burden of 31,441 beats (15%) was captured with variable morphology. TTE showed mild global hypokinesis of the left ventricle and ejection fraction (EF) of 40%. Coronary arteries were normal on cardiac catheterization. Cardiac magnetic resonance revealed epicardial late gadolinium enhancement suggestive of fatty infiltration of the distal lateral wall of the left ventricle (LV) indicative of Arrhythmogenic left ventricular cardiomyopathy (ALVC). The basal anterolateral wall of the LV appeared thin and dyskinetic, and the right ventricle was normal in size and function. Optimal medical therapy was initiated with metoprolol, sacubitril/valsartan, dapagliflozin, and spironolactone. A dual-chamber ICD was placed for primary prevention. Over time with medical management, her PVC burden reduced, and LVEF improved to 50%. A multigene panel for cardiomyopathies identified a mutation in titin (TTN) gene variant of unknown significance. Discussion: Previously thought to affect only the right ventricle, arrhythmogenic cardiomyopathy (ACM) is a rare genetic disease characterized by fibrofatty replacement of the ventricular myocardium. ALVC refers to the predominant LV dominant phenotype of this disease. The most frequent genetic mutations occur in the genes plakophilin (PKP2), desmoplakin (DSP), and desmoglein (DSG2). However, we report a case of ALVC in the setting of titin (TTN) gene variant, which is a gene usually implicated in dilated cardiomyopathy. However, the clinical significance of the TTN gene variant identified in our patient remains unclear as more studies are needed to link it to the phenotypic findings.
Abstract 15878: Relationship Between Cardiac Biomarkers and Echocardiographic Parameters of Cardiac Structure in Patients With Diabetes
Authors: Viraj Raygor, Matthew Segar, Zainali Chunawala, Sonia Shah, Ambarish Pandey, Alvin Chandra
Journal: Circulation (2022)

Introduction: Current guidelines recommend N-terminal pro-brain natriuretic peptide (NT-proBNP) screening to identify subclinical structural cardiac abnormalities in patients at risk for developing clinical heart failure (HF) such as those with diabetes (DM). High-sensitivity cardiac troponin (hs-cTn) is another cardiac biomarker that can predict incident HF in patients with DM. It is unclear how the addition of hs-cTn to NT-proBNP screening impacts the detection of subclinical abnormalities of cardiac structure in patients with DM. Methods: Participants with DM but without known CVD at visit 5 (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) study who had available cardiac biomarker data and detailed echocardiographic assessment were included. The associations of abnormal hs-cTn and/or NT-proBNP (defined as hs-cTn ≥ 6 ng/L and NT-proBNP ≥ 125 pg/mL) with abnormal echocardiographic measures of cardiac structure were assessed using multivariable adjusted linear regression analysis. Results: Participants (N=797, mean age 75±5y, 43% male, 77% White) had mean BMI 31±6 kg/m 2 , systolic blood pressure 129±17 mmHg, and serum creatinine 1.0±0.3 mg/dL. As shown in the table, abnormal NT-proBNP was associated with higher left ventricular (LV) mass, LV end-diastolic volume (EDV), left atrial (LA) volume, and E/A ratio. Abnormal hs-cTn was associated with lower global longitudinal strain (GLS), but no other measures of cardiac structure. The combination of abnormal hs-cTn and NT-proBNP was associated with higher LV EDV and LA volume and lower GLS. Conclusion: Among participants with DM free of CVD, abnormal NT-proBNP was associated with several echocardiographic parameters of abnormal cardiac structure. The addition of hs-cTn to NT-proBNP did not significantly improve detection of structural cardiac abnormalities other than low GLS.